Speaking about the dynamics of the incidence of syphilis, it is necessary to pay attention to a certain cyclicality of a uniform decrease and increase in the incidence every 15-20 years. Over the past 5 years, the registration of all forms of syphilis has decreased by 1.5 times against the background of a stable level of late forms. An increase in the number of cases of mixed infection was noted.
The diagnosis and treatment of syphilis during pregnancy requires special attention in order to prevent infection of the fetus. Read more about the management of this group of patients in this article on estet-portal.com
- Epidemiology and risks of untreated syphilis during pregnancy
- Clinical presentation of syphilis during pregnancy
- Features of the treatment of syphilis during pregnancyty
Epidemiology and risks of untreated syphilis during pregnancy
New guidelines for improving the laboratory diagnosis of syphilis were approved, according to which, as diagnostic methods of this disease, it is recommended to use:
- microprecipitation reaction in various modifications;
- enzymatic immunoassay or passive haemagglutination test;
- immunofluorescence reaction.
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In addition to serological reactions, patients with latent late forms of syphilis are characterized by certain clinical picture.
These are usually patients over 40 years of age who are in somatic hospitals mainly of the dermatovenereological profile, more than half of them in the anamnesis − treatment of syphilis with penicillins. Most patients have nervous system disorders:
- encephalopathy of mixed origin;
- asthenoneurotic syndrome;
- cognitive impairment.
According to the World Health Organization (WHO), in women with untreated syphilis during pregnancy, 25% of cases end in stillbirth, 14% − neonatal death, i.e. the total perinatal mortality is about 40%. Clinical presentation of syphilis during pregnancy
The fetus becomes infected
from the moment the placenta is formed, when the placental blood flow begins to function − from the 20-21st week of pregnancy. Pale treponemas enter the fetus usually hematogenously (via the umbilical vein), lymphogenously (by the lymphatic clefts of the umbilical cord), and also with the mother's bloodstream (through the toxin-damaged treponema pallidum placenta).
Infection is also possible during childbirth(when passing through an infected birth canal). The possibility of transmission of syphilis to the fetus depends on the duration of the disease of the woman, as well as the clinical form of syphilis.
In case of
primary syphilisduring pregnancy, cervical chancre is characteristic (penetration of the pathogen into the softened cervix), manifestations of secondary syphilis go unnoticed in 25% of pregnant women. When infected with syphilis on the eve of pregnancy or during the first months,
spontaneous abortionsoften occur, at the 4-5th month of pregnancy − premature delivery of a dead fetus, on the 6-7th - birth of a child with active manifestations of syphilis.
Clinical manifestations and complications of tertiary syphilis If infected in the last months of pregnancy or on the eve of childbirth, the child may not yet have signs of infection, but when passing through the birth canal, the child may become infected and, in this case, develop
sya acquired syphilis. Peculiarities of treatment of syphilis during pregnancy
When working with pregnant women, it is imperative to study the pregnancy history. It is important to communicate with gynecologists in order to establish a timely diagnosis and provide the necessary treatment to these patients.
When a pregnant woman is registered(12 weeks), screening for syphilis is performed, which is repeated in the III trimester of pregnancy (29 weeks). If the woman was not registered for pregnancy, a syphilis test is performed at the time of delivery.
Treatment of syphilis during pregnancy is carried out mainly in dermatovenerological or obstetric hospitals (depending on the course of pregnancy, the condition of the pregnant woman, etc.).Penicillin remains the drug of choice
. Benzylpenicillin/penicillin G is recommended. WHO recommends the use of benzathine benzylpenicillin. Treatment regimens depend on the form of syphilis and the duration of the disease.
, must include:
informing the public;- general population survey;
- timely detection of cases of syphilis in the population and the appointment of treatment;
- examination of sexual partners;
- work in an epidemic focus;
- timely quality testing of pregnant women;
- application of modern methods of diagnosis and treatment of patients with syphilis;
- diagnosis by dermatovenereologists;
- establishing interaction between gynecological, dermatovenerological services and family doctors.